Provider Demographics
NPI:1013059120
Name:FLORIDA INTEGRATED HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:FLORIDA INTEGRATED HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAIDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEYEMO
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN
Authorized Official - Phone:813-679-0133
Mailing Address - Street 1:3202 W BAKER ST
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-2849
Mailing Address - Country:US
Mailing Address - Phone:813-704-6857
Mailing Address - Fax:813-756-6938
Practice Address - Street 1:1905 W BAKER ST STE B
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-1601
Practice Address - Country:US
Practice Address - Phone:813-719-3278
Practice Address - Fax:813-754-7540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
FLPH225313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2008656OtherPK
FL031992900Medicaid
FL031992900Medicaid